Harm Reduction – Looking Back by Bob Lynn Ed.D

When Sobell and Sobell published their controlled drinking study in 1978, they set Harm Reduction on a path from which it has taken more than 50 years to recover (SOBELL, M . B. & SOBELL, L. C. (1978) Behavioral Treatment of Alcohol Problems: Individualized Therapy and Controlled Drinking). After the publication of this study, the addiction treatment field reacted with strong condemnation and quickly shot the messenger. This set off a long-standing conflict between science and experience-based treatment. When I entered the field 50 years ago, Methadone Maintenance was considered the default treatment for those who could not remain abstinent. Today, many in the greater treatment community continue to view Medication Assisted Treatment (MAT) through a marginal lens, even though traditional treatment models have questionable outcomes. This is because Harm Reduction stands contrary to rigid etiology and addiction treatment beliefs. Traditional programs that lack standards of care and outcomes often chastise Harm Reduction as encouraging relapse. This is based on the belief that all users are the same and there is a single pathway to a quality life.

One can appreciate the gravity of my situation when in 1990, a New Jersey medical school approached me to develop a Harm Reduction training program. I realized that this undertaking could strike a significant blow to my professional status, so I agreed on the contingency that I could develop a qualitative methodology for examining Harm Reduction in the UK and the US. I chose these regions because Harm Reduction programs were already well established. 

In my research, I spent a great deal of time analyzing methadone programs in the US. When I began my studies, needle exchanges, safer injection services to prevent HIV transmission, and experiments in controlled drinking were just emerging in the realm of Harm Reduction. These practices had not yet received wide acceptance from the political and treatment communities. I recall one place that had such a caring MD that all patients in need were medicated within one half hour of walking into the clinic. These patients also had their choice of continuing methadone or being detoxed. This clinic was truly a caring and professional program. Most other programs during this time, although helpful, resembled an assembly line.

In the UK, I researched Harm Reduction services such as the “Dodgy/Dangerous Punter” program. This program gathered and distributed profiles of “punters” to alert sex workers about abusive customers. Sex workers were also offered health services including needle exchange, safe injection training, and counseling. Another notable program I researched was the “Up Your BUM” program, which taught program participants how to safely ingest drugs anally. These are examples of some of the creative Harm Reduction efforts I experienced.

In the UK, I also researched police interventions. One such intervention was providing on-site counseling when an individual was arrested for a drug-related charge. The therapist would engage the client at the police station and then visit them at their home the next day. If the individual remained in contact with the counselor, not necessarily stopping drug use, all charges were dropped. 

One of the most moving stories happened in Hull which was the needle-using capital of the UK. While visiting a Harm Reduction site, a 12-year-old boy came by on a small bicycle and parked in front of the counseling center. He appeared confused and stood there with a very cautious look on his face for a few moments. I thought he was simply lost or came to the wrong place. However, to my surprise, a counselor walked up to him, put an arm around him, and led him into the center. I reflected on how this 12-year-old needle user was now in safe care. His counselor was hopefully able to help the boy negotiate a pathway forward that worked for him, likely saving his life.

After my time in the UK, I returned to the US with a suitcase filled with materials from my Harm Reduction research, some of which I still have today. I used these resources to complete my training program. Today, I use these experiences and knowledge to advocate for Harm Reduction. I believe that after 50 years of stigma, change is now possible.

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Dr. Lynn is an internationally recognized lecturer, researcher, and clinician in the field of Counseling Psychology and Addiction. He is CEO/Founder of The Addiction and Behavioral Health Alliance, Faculty for Rutgers Institute of Addiction Studies, International Consultant in treatment delivery systems, Director of Program Development-International for C4 Recovery Solutions, and the Clinical Director for the National Council on Alcohol and Drug Dependence NJ Juvenile Justice System Adolescent Evaluation and Treatment Project.